=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245268788
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE D WAITE ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 N STOCKTON HILL RD STE 108
-----------------------------------------------------
City | KINGMAN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86401-4140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-255-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13000 N 103RD AVE STE 59
-----------------------------------------------------
City | SUN CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85351-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-594-4126
-----------------------------------------------------
Fax | 623-594-4127
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 289530
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------